# SAN MIGUEL HOSPITAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Alta Vista Regional Hospital
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396716643
- **Authorized official:** RANDY MICHAEL COOPER (SVP FINANCE OP/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (615) 221-3840

## Contact information

- **Practice address:** 104 LEGION DR, LAS VEGAS, NM 87701-4804
- **Practice address phone:** (505) 426-3500
- **Practice address fax:** (505) 454-9502
- **Mailing address:** 104 LEGION DR, LAS VEGAS, NM 87701-4804
- **Mailing address phone:** (505) 426-3500
- **Mailing address fax:** (505) 454-9502

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 3005 | NM | Yes |

## Other

- **Enumeration date:** 01/26/2006
- **Last updated:** 08/11/2020